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There is compelling evidence that eating disorder behaviors are used to help regulate strong negative emotions. For example, if an individual is feeling ashamed or sad, binge eating might help to reduce such feelings temporarily. This helps to explain why someone might continue to binge eat over time despite many consequences, including weight gain.”

– Doctoral candidate Nora Durkin

Monday, May 9, 2016

Emotion Regulation in Eating Disorder Recovery

“Why don’t you just eat something?”

As many sufferers of disordered eating know, eating disorders aren’t really about food or weight. They’re not about vanity or control or willpower. They are not a lifestyle choice. And they aren’t exclusive to white, upper-to-middle class females.

Unfortunately, these misconceptions about the causes of disordered eating are widespread and potentially dangerous: it’s estimated that only about one in 10 people suffering from eating disorders gets the help he or she needs, due in part to patients’ fears of being stigmatized and under-diagnosis from healthcare professionals.

Nora Durkin, a doctoral candidate in the Department of Educational Psychology’s Counseling and Student Personnel Psychology Program, wants to help improve understanding about the causes and consequences of eating disorders, and inform better treatment programs for the broad range of people who suffer from them.

Durkin is investigating a growing body of research that suggests there is an important relationship between disordered eating and emotion regulation: the ability to recognize and accept an emotion, as well as the ability to influence the intensity of–and our reaction to–an emotion we’re experiencing in order to accomplish some sort of goal.

“There is compelling evidence that eating disorder behaviors are used to help regulate strong negative emotions,” says Durkin. “For example, if an individual is feeling ashamed or sad, binge eating might help to reduce such feelings temporarily. This helps to explain why someone might continue to binge eat over time despite many consequences, including weight gain.”

Exploring emotions and eating disorders in diverse populations

Eating disorder treatments targeting emotion regulation difficulties look promising, but there is a dearth of research about emotion regulation and eating disorder recovery – particularly among individuals who are broadly representative of the eating disorder population.

“Eating disorders are pernicious illnesses that have high mortality rates–in fact, eating disorders have the highest mortality rate of any psychiatric illness,” Durkin says. “There’s a great need for improved evidence-based treatments for these conditions in diverse populations, as well as a more thorough understanding of what causes and maintains them.”

Recent studies show that non-whites are just as likely as whites to struggle with eating disorders, but due to the historically biased view that eating disorders only affect white women, relatively little research has been conducted utilizing participants from racial and ethnic minority groups. Durkin is hopeful that her research sample will be more heterogeneous and diverse than has been utilized in prior research, and thus more accurately representative of the eating disorder population.

Durkin’s research examines the extent to which emotion regulation difficulties persist during recovery from eating disorders, and also whether specific negative emotions–such as guilt and shame–are elevated among individuals in recovery.

“What initially causes an eating disorder isn’t necessarily what keeps it going; this can make treatment difficult,” she says. Durkin hopes that the results of her research will contribute to more effective eating disorder treatments and maintenance models of disordered eating.

“I am incredibly fascinated by just how complex these illnesses are,” she says. “No one has yet to identify the exact pathways to an eating disorder, but what we do know is that eating disorders are caused by a multitude of biological, psychological, and social factors.”

Bringing research to the real world

Before enrolling in the Counseling and Student Personnel Psychology doctoral program, Durkin worked as a research coordinator at the University of Minnesota Center for Eating Disorders Research (MCEDR). She studied tobacco use and comorbidity in bulimia nervosa as an undergraduate, and published the results in the International Journal of Eating Disorders. And while Durkin is excited about the potential findings of her dissertation research, her true passion is working with people who are affected by eating disorders.

“There is a large gap in the field between research and clinical practice. I plan to find ways to share my study results with those who directly work with clients with eating disorders,” says Durkin. “I’m also eager to apply my findings directly to my own clinical work.”

According to her advisor, Dr. John Romano, Durkin is already making an impact on students, patients, clinicians, and researchers: “Nora has accumulated an impressive array of applied experiences in community and University of Minnesota clinics and at the University of Minnesota Student Counseling Services. In addition, she has supervised MA counseling students in practicum and served as a group trainer/observer for MA group counseling students.”

Driven by curiosity, shaped by family, supported by mentors, and inspired by others

Raised in Wisconsin by parents who worked in healthcare, Durkin says she’s always been inquisitive about the human condition, and has long had a desire to work in some kind of helping profession.

She was motivated to study at the University of Minnesota as an undergrad because of its reputation in research and healthcare, and also because she wanted to be in a diverse setting: “I was drawn to the urban environment, which has been critical in my development as a culturally responsive provider.”

Durkin credits her advisors and mentors with supporting and shaping her professional identity. “My doctoral advisor, John Romano, has been a constant source of support throughout my doctoral training. His belief in my abilities and his flexibility with my research pursuits have been critical to my success as a researcher, as has his extensive knowledge and research background (not to mention his many decades mentoring graduate students).”

Durkin has also worked with researchers Dr. Carol Peterson and Dr. Scott Crow at the MCEDR. “They’re both prolific researchers who are leaders in the field in eating disorders and so I have been so fortunate to grow as both a researcher and clinician thanks to their cutting-edge work, willingness to collaborate, and unwavering support and enthusiasm,” she says.

Compared to other areas of psychology, the field of eating disorders is relatively new. Research on representative populations is scarce. Funding is limited. Yet Durkin is hopeful for the future of eating disorders research: “I’m optimistic about the increased emphasis on emotional processes, a key piece in the successful treatment of eating disorders. There have been many advancements in eating disorders research over the last three decades. Given new technology, and the many bright researchers and clinicians who are committed to improving prevention and treatment efforts, I believe there will be plenty more.”